Healthy and Well Kids in Iowa

Iowa Department of Human Services

A Summary of Wellmark Health Plan of Iowa Benefits

Healthy And Well Kids in Iowa (hawk-i)

This is only a summary of the benefits covered by Wellmark Health Plan of Iowa through the hawk-i Program. If you have specific questions or want more details about the benefits covered, refer to benefits policy booklet, or call Wellmark at 1-800-211-6797.

Plan Benefits /

Wellmark Health Plan of Iowa’s Blue Access Plan

Doctor visits / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s network.
Benefits apply when provided by a Primary Care Physician (PCP)-type provider. Benefit not available if you go out of network.
Specialists / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s network.
Benefit not available if you go out of network.
Immunizations (shots) / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s network.
Benefits apply when provided by a PCP-type provider. Benefit not available if you go out of network.
Check-ups / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s network.
Benefits apply when provided by a PCP-type or Obstetrics and Gynecology (OBGYN)-type provider. Benefits not available if you go out of network.
Hospital Care / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s network. Benefit not available if you go out of network.
Planned admission: you or your doctor needs to call Wellmark at 1-800-558-4409 within one business day after the admission.
Emergency admission: you or your doctor must call Wellmark at 1-800-558-4409 within 24 hours.
Surgery / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s network. Benefit not available if you go out of network.
Emergencies / Covered if you go to the emergency room for treatment, if it is not an emergency, you may have to pay a $25 co-payment.
Out-of-network Coverage / Covered if you go to the emergency room for treatment, if it is not an emergency, you may have to pay a $25 co-payment.
Eye exams / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s network. Benefit not available if you go out of network. Pays for one exam every 12 months.
Eye glasses & contact lenses / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s Network. Benefit not available if you go out of network.
Pays up to $100 in benefits per year. The member must pay any amount over $100. Coverage for frames is limited to one frame every 12 months. Coverage for lenses is limited to two lenses every 12 months.
Chiropractic services / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s Network. Benefit not available if you go out of network.
Primary Care Physician must notify Wellmark of a referral to receive Chiropractic care beyond the first 12 visits.
Prescriptions / Covered if you use a network pharmacy. Only generic drugs are covered; if you choose a brand name drug and a generic equivalent drug is available, you will pay for the brand name drug. Brand name drugs are not covered unless approved by Wellmark. Quantity limitations and step therapy may apply for certain drugs.
Mental Health Services / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s network. Benefit not available if you go out of network.
Substance Abuse Services / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s network. Benefit not available if you go out of network.
Hearing screenings / Covered if you receive services from health care providers who are part of Wellmark Health Plan of Iowa’s network. Benefit not available if you go out of network.
Required Referrals / Freedom to choose any provider in the Wellmark Health Plan of Iowa network. For preventative benefits, members must visit an in-network PCP-type or OBGYN-type provider.
Phone numbers and web site address / Customer Service: 1-800-211-6797
You may find the providers who participate with Wellmark Health Plan of Iowa Blue Access by going to
Additional Benefits / Personal Health Assistant 24 hours 7 days a week. Call 1-800-724-9122.

• If you cannot find a provider in your area that accepts the health plan you are enrolled in, you must contact the health plan first before receiving services. The health plan will help you find a provider who accepts their plan or will approve for you to go to another provider.